Whether Ignazio Marino adds that last credential to his impressive resume will be decided by a runoff election in Rome’s mayoral race. The June 9-10 balloting pits the surgeon against incumbent Gianni Alemanno, a former neo-Fascist street protester who in 2008 became the city’s first right-wing mayor in decades.

Among the questions swirling around the unusual candidacy, one seems inevitable: Why would a 58-year-old transplant doctor pack up a lucrative career and life-saving surgical instruments to take up the keys to City Hall in the eternally chaotic, corruption-plagued Italian capital?

Marino cheerfully expounded on the question, while skirting another about an expense scandal that cost him his job in Sicily. He recounted in an interview with The Associated Press how he wrestled with the decision to try to improve people’s quality of life with another kind of tool: politics.

The candidate of the center-left Democratic Party ascribed his ambition to become mayor of Rome to a kind of fatal attraction he cannot resist — “impossible challenges.”

Marino has a track-record for such Quixotic moves: Nearly 15 years ago, Marino traded Pittsburgh for Palermo, leaving his well-paid work as surgeon and researcher at one of America’s most prestigious transplant institutions to pioneer a transplant hospital in Sicily, where just about any socially productive initiative runs the risk of intimidation and infiltration by the Mafia.

“Most people thought that I’d lost it,” Marino said, referring to his decision to establish the Sicilian center, now a bright spot in an often bleak landscape of backward citizen services on the island. The same penchant for improbable challenges also applies to his jump into politics, with a successful run for the Italian Senate in 2006 — and now, his mayoral bid.

“I know it’s an almost impossible challenge to reorganize a town with the complexity of Rome,” Marino said, while insisting that by focusing on everyday quality-of-life for Romans, and the throngs of tourists who pour into the city, improvement will come.

After his first-place finish in the opening round of voting last month, Marino made brief remarks to his exhilarated supporters, his metallic-framed glasses, gentle voice and soothing smile more evocative of a family pediatrician than a hard-nosed politician aiming to tackle Rome’s perennial problems.

Marino spoke of the “elderly woman who is afraid to leave her house because she might fall” in Rome’s pothole-pocked streets. And he promised to create jobs for Rome’s unemployed young people, in a country where youth unemployment has soared to 40 percent.

Marino hasn’t made much of his transplant surgeon background in the campaign. Still, his slogan — “Rome is life” — riffs on his life-saving skills. And his campaign webpage photo shows him in in surgical scrubs, with a team of doctors operating in the background.

He captured 42 percent of the vote in the first round of balloting featuring 19 candidates, most of them minor. His nearest rival, the incumbent mayor, trailed by some 12 percentage points. But it’s hard to say whether the results reflect Marino’s own popularity or the unpopularity of Alemanno, whose administration has been plagued by mass transit strikes.

In a recent campaign rally in a traditionally left-leaning middle-class neighborhood, Marino drew about 50 people — not much of a bigger a crowd than the one waiting for a bus around the corner.

And another question casts a shadow over the would-be mayor: the circumstances of his abrupt resignation in 2002 as director of Sicily’s ISMETT transplant center, his signature accomplishment that is a partner facility of the University of Pittsburgh Medical Center.

The U.S. institution at the time said hospital auditors had found a pattern of “intentional duplicate” expense accounts submitted by Marino. The Pittsburgh medical center declined comment about Marino other than to say that a 2009 Pittsburgh Tribune-Review article about the alleged expense irregularities was “accurate.” That article quoted center spokesman Paul Wood as saying: “Dr. Marino was compelled to resign solely as a result of irregularities uncovered by UPMC auditors. Period.”

Marino declined to comment directly about the alleged expense duplication, which, according to the newspaper, totaled more than $8,000.

“There are conflicts, but you solve the conflicts and life goes on. And this is what happened,” Marino said. The doctor joined Thomas Jefferson University and Hospitals in Philadelphia in fall 2002 as a professor of surgery, staying until the end of 2009, with the last few years overlapping with his first stint in the Senate.

Like many notable Italian doctors, Marino went abroad to sharpen his skills, eventually landing in Pittsburgh — where he was mentored by renowned transplant surgeon Thomas E. Starzl.

Although Marino performed his last transplant in 2007, he still performs other liver surgery, and follows up with former patients.

“Even this morning, I got an SMS from a lady I transplanted 15 years ago, who was worried about her immune suppression,” said Marino, who gave his 45-minute interview standing up, explaining that he is used to standing on his feet for 12 hours during surgery.

But he conceded he will have to make a clean break from medicine if he makes it into City Hall: “I know I cannot probably go into the operating room again if I were elected mayor,” said the doctor. “This will be tough.”

Opinion polls have found Italians increasingly disenchanted by their ruling political class, frequently bickering or sullied by scandals. So far, Marino’s own expense scandal hasn’t surfaced in the Rome campaign, where the first round of voting showed a sharp drop in turnout. Mass transit and urban crime have dominated, with Alemanno reminding voters of his get-tough-on-crime platform and Marino saying he would step up squad car patrols —a rare sight in Rome — to make residents feel safer.

Marino acknowledged the public mood, while evidently seeking to distance himself from the political pack.

In Italy, Marino said with a wry smile — “politics is … for people not capable of doing anything else.”

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Peter Jackson in Harrisburg, Pennsylvania, and Matt Moore in Philadelphia contributed to this report.

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